Road Map to China

By Tamela Hatcher, MEd

I am thrilled to have been asked to share my story regarding my experience teaching ICEA Professional Childbirth Education (PCBE) and Birth Doula workshops in China. This journey reminds me of the Penny Simkin Roadmap to labor. I have traveled the scenic route, in which I have experienced the expected and normal things. I have traveled some bumpy roads that posed great challenges.  On other occasions, my foreign travels and teaching have moved forward so fast that I felt like I was on a super highway.

The Super Highway: In October of 2015, I facilitated a concurrent session at the ICEA/Lamaze joint conference.  Three ladies from China attended this conference.  I remember looking at one lady during the 90- minute session and wondering how effective my presentation was for someone that spoke a different language and was thankful for the pictures I had added. However, I made a mental note for future presentations to be more aware of ICEA as an international organization.  It is the first word in our name, and yet I had never put myself in the role of the international member.

Shortly after the conference, I received an email from China requesting that I facilitate a workshop with a grassroots birth organization called YANMA, a trustworthy and honorable organization.

In January of 2016, I had my visa, passport, plane ticket for this 14-17 hour flight, and enough vacation time from my job to embark on this journey.  I was excited, scared, anxious and happy all at the same time. I reminded myself that this was similar to how many families feel at birth.

Our ICEA birth work and collaboration in China has been very productive.  More than 500 ladies and 1 gentleman have attended the workshops.  Many have gone on to certify, and some have started successful and thriving birth businesses.

The Bumpy times:  We had some communication issues and misunderstandings along the way, which required some difficult conversations.  These bumps in the road taught us some valuable lessons.

We realized some things were extremely difficult or impossible to achieve in other countries, such as observing three births. Some of these were simple to fix, like our ICEA required reading list of books that were not available in China.  The authors, Amis and Green, were quick to come to our aid. They gave us permission and helped to develop a plan to translate this popular book into Chinese. It is projected to be available to our students in July of 2017.

The ICEA organization has made concerted efforts to become more global-friendly.  We have moved the exam to an online format that can be taken in English, Chinese, or Spanish.  We have updated our website.  We are collaborating with members from other countries to develop key documents in other languages. Most importantly, we are working on providing alternatives to observing births in the hospital settings and streamlining our certification programs.

Most women in China are required to labor in bed without the assistance of husbands or birth doulas.  Some midwives communicated the trials and frustration of caring for as many as 17 moms in a day.  Shared rooms, overcrowding, and the lifting of the one-baby policy all posed new challenges for health care facilities.  The cesarean rates are very high, and everyone seemed committed to finding solutions. We all want safe, kind, compassionate and empowering births.  How we achieve this and what it looks like varies.

The scenic route: This part of the journey has been amazing!  I have met some incredible and passionate birth workers.  I have learned so much about this beautiful and gentle culture.  During 2016, my husband and I were elated to reciprocate the hospitality that has been extended to our family by hosting five of my birth colleagues in our home as they learned first-hand about birth in the United States.

Indeed, this has been a rewarding and beautiful journey.  The people are so appreciative of the ICEA education and workshops.  We have found creative work-arounds for our language barriers and have enjoyed learning about and celebrating our differences.  I have had the privilege of touring new birth businesses, hospital birthing facilities, and confinement centers for postpartum women, meeting many talented and committed birth doulas, aspiring professional childbirth educators, doctors, midwives and hospital administrators. I have enjoyed sharing many meals, experiencing Chinese traditions, Chinese medicine, massage, yoga, bath houses, temples, train rides, Uber transportation, the circus, We Chat and many new APPS, and climbing a mountain where I enjoyed tea with one of my new friends.

I have embraced the two hour lunch/nap times that are taken daily.  I must admit, the first time I was given a mat and pillow, I spent the time feeling anxious about all of the things that I should be doing.  Now, I look very forward to this quiet time to reflect, embrace and recharge.

Is teaching hard work? You bet it is!  Is it worth it? Absolutely.  During this short time, I have been able to witness a shift in healthy birth practices.  Some fathers are now allowed to participate in the birth of their children.  Some hospitals have welcomed birth doulas.  One lady from our first ICEA workshop recently shared with me that she had the birth of her dreams. She was supported by two other students from that first class.  One was a doctor and the other a midwife, who served as her birth doula.  She wore her own fun clothing, had her husband with her, enjoyed food, drinks, friends, and literally danced her adorable baby into this world.

I am so thankful for the great teachers and maternity workers that have paved the road for me to do this work.  Because of them, I am living my dream.

Tamela Hatcher, MEd, has been fascinated with birth for as long as she can remember.  When Tamela was five years old, a wonderful maternity nurse placed Tamela’s hand on her pregnant belly, and Tamela felt the nurse’s baby kick.  Tamela was amazed and curious.  By 12 years of age, she had read every book about birth she could get her hands on, and she knew she wanted to work in the maternity or education field.  Tamela had a great middle school teacher who said, “Why don’t you do both?” The teacher talked to Tamela about a couple of fairly new organizations started in the 1960s called ASPO (now Lamaze) and the International Childbirth Education Association (ICEA).  Tamela has enjoyed teaching childbirth education to more than 3,610 couples. Currently, she serves as the Education Director for ICEA, and has coordinated birthing education and doula services for 26 years. Recently, Tamela retired to pursue her love of traveling and teaching.

Is Distracted Parenting a Problem?

By Donna Walls, RN, BSN, ICCE, IBCLC, ANLC

A relatively new phenomenon is occurring with some possibly serious implications for infants and children. Concerns are being expressed related to “distracted parenting”. These concerns center around parents whose attention toward their children is now directed to electronic devices, especially cell phones.

In a study in the journal Pediatrics, the authors observed parents dining with their children (ages birth to 10 years) at fast food restaurants. The researchers noted about a third of parents spent the entire meal fully absorbed with their mobile devices, with no attention given to their children. The children who sought attention from their parents were often ignored by their parents who were engaged only with their devices.

Dr. Jenny Radesky, MD, a pediatrician, the study’s lead author said: “One child tried to raise his caregiver’s face to look at him and not the screen, another said he wasn’t done with food that was thrown away, and each time the caregiver just went back to the screen.”

Other child behavior experts cite concerns including research showing high tech using parents are less likely to share family meals and less likely to report satisfaction with their leisure family time when compared to lower technology using parents.

Technology preoccupied parents may also lead children to “act out” as a means of getting their parent’s attention. NBC News’ Brian Alexander reported that distracted parenting can contribute to developmental delays in speech and cognition, and lead to behavioral issues, such as temper tantrums, anxiety and resistance to discipline. “In extreme cases of neglect, with very little interaction between parents or other caregivers, children can develop a variety of pathologies.” Children may be more likely to feel abandoned and unworthy and as they grow older and  may likely be at risk of becoming depressed and angry.

In a new animal-based study published in the journal Translational Psychiatry, scientists show that distracted parental attention may sometimes have detrimental effects on babies’ development, especially their ability to process pleasure.

“The fact that the adolescent mice showed signs of compromised pleasure sensations suggests that just like with sensory systems such as sight and hearing, there may be a critical window in which newborns need to be exposed to certain behaviors from mom in order for their nervous system to develop properly. In this case, the lack of consistent, repetitive and reliable attention appeared to affect the animals’ ability to develop proper emotional connections to help them understand pleasure. “It makes perfect sense,” says Baram. “We do need rhythms and consistent exposure beyond the ears for them to be capable of discerning complex patterns in speech and music. We need patterns for the visual system to develop. I guess we need predictability and consistency for the emotional system to develop”.

“What we are proposing is that there is a sensitive period in which maternal care needs to provide consistent patterns and sequences of behavior so the baby’s brain can perceive them to develop normally emotionally. The predictability of maternal care seems to engage the pleasure system, and the pleasure system needs to be engaged so the neurons involved will fire together and then will wire together,” she says.

In the past five years, research studies of this phenomenon have multiplied. Linda Blake and Ben Worthen cite studies showing a correlation between increased incidents of child playground injuries and parents’ technology-induced inattention. Another study at Boston Medical Center, conducted by pediatrics specialist Jenny Radesky shows that parents and other caregivers using hand-held devices were more likely to punish children harshly for minor mischief.

In recent news from Ohio, a 7 year old died in a car crash when the mother was preoccupied and talking on her cell phone. The mother survived the crash.

Another concern is the possible negative health effects of radiation exposures. The International Agency For Research on Cancer, American Cancer Society and the National Institute of Environmental Health and Sciences all agree that studies have raised some concerns and further investigation and research should be conducted, according to the National Cancer Institute. In 2011, after reviewing evidence from a study conducted by 31 scientists around the globe, the World Health Organization categorized non-ionizing radiation as a “carcinogen hazard” next to lead, engine exhaust, and chloroform.

What microwave radiation does in most simplistic terms is similar to what happens to food in microwaves, essentially cooking the brain,” Black said. “So in addition to leading to a development of cancer and tumors, there could be a whole host of other effects like cognitive memory function, since the memory temporal lobes are where we hold our cell phones.”  -Dr. Keith Black, chairman of neurology at Cedars-Sinai Medical Center in Los Angeles.

With growing bodies and developing brains, cell phone radiation could potentially have an even greater effect on babies and young children, so minimize their exposures by:

  • Moving phones several feet away from infants and children
  • Turn off when not in use and in close proximity to a child
  • Do not place your phone in the infant carrier or stroller
  • Put your phone on airplane mode while holding or feeding the baby
  • Do not allow infants or young children to use the cell phone as a toy.
  • Use a protective cover while breastfeeding your little ones if you use your cell phone during nursing sessions.

Some experts are beginning to caution against extended cell phone use during breastfeeding or bottle feeding, as numerous studies have found that the feeding time is critical to mother-child bonding and socialization. Dr Kateyune Kaeni, a psychologist specializing in maternal mental health at Calfornia’s Pomona Valley Medical Center says eye-contact is vital in building a secure connection between mother and child.

Dr. Kaeni continues “If baby is trying to make contact with you by making noises or smiling and they can’t, they learn over time that they can’t rely on you to respond, it runs the risk of them becoming either anxiously attached to your or insecurely attached to you and they will ramp up their behavior until you pay attention.” She added that a distraction such as a smartphone could mean mums are missing cues that baby is “full or they’re still hungry”. Texting while breastfeeding as even spawned a new term- “brexting”- cell phone use while nursing.

In the breastfeeding (and bottle feeding) arena there are other concerns associated with parental inattention. Mothers may miss feeding cues, skip or delay feedings and endanger the infant’s nutritional status and compromise her milk supply. They may also miss subtle cues that the infant is latched incorrectly leading to poor milk transfer. Mothers and their ≤24-week-old bottle-feeding infants (N=28) visited our laboratory for a video-recorded feeding observation. Findings demonstrated that “mindless feeding” is associated with greater infant formula/milk intakes and lower maternal sensitivity to infant cues.

On the other side of the coin, some mothers have reported that having technology time provides a welcomed and often necessary reprieve from the responsibilities of parenting. Some felt like they could be more “present” with their infants and children when they had some technology break time.

Other parents reported feeling like the use of technology and cell phones has brought their families closer. Some felt that mothers/parents have always had “distractions” like radio, TV or even older children requiring their attention which is no different than technology distractions.

Is this a topic that might be considered part of the childbirth education classes or included in parenting or breastfeeding classes? It certainly is an intriguing topic that will certainly become more relevant in the near future. Until then, an awareness of the concerns may help us to respond to parental questions or concerns.

Brunstrom JM1, Mitchell GL. Effects of distraction on the development of satiety. Br J Nutr.  2006 Oct;96(4):761-9.…/201412/are-you-distracted-parent…/brexting-impacts-baby-bonding-during-breastfeeding

For Decades, Research Has Verified the Benefits of Doula Care

The word “doula” first used in an article published in 1969 by Dr. Dana Raphael, a medical anthropologist who believed in the need for female companions to guide mothers through pregnancy, birth, and postpartum. In the midst of their research on maternal-infant bonding, Drs. Marshall Klaus and John Kennell verified the benefit of labor support.  They first published an article documenting these benefits in the New England Journal of Medicine in 1980. Several years later they followed up with more research published in the Journal of the American Medical Association.

The Cochrane Library published its first review of literature in 2003 affirming the benefits of labor support.  That publication has been updated several times (the last time being in 2013) and the results remain the same: doula support results in many benefits and with no adverse effects. To quote the executive summary:  “The review of studies included 23 trials (22 providing data), from 16 countries, involving more than 15,000 women in a wide range of settings and circumstances…. Women who received continuous labour support were more likely to give birth ‘spontaneously’, i.e. give birth with neither caesarean nor vacuum nor forceps. In addition, women were less likely to use pain medications, were more likely to be satisfied, and had slightly shorter labours. Their babies were less likely to have low five-minute Apgar scores. No adverse effects were identified. We conclude that all women should have continuous support during labour. Continuous support from a person who is present solely to provide support, is not a member of the woman’s social network, is experienced in providing labour support, and has at least a modest amount of training, appears to be most beneficial.”

An article published in 2013 in the American Journal of Public Health Katy Kozhimannil, PhD and others demonstrated the financial benefits that doula care can have on the health care system.  Because of the lower intervention rate, paying doulas is actually cost effective.  Several states now either have or are considering Medicaid reimbursement for doula care.

The American College of Obstetricians and Gynecologists (ACOG) have now released two Committee Opinions in support of doula support during labor.  Safe Prevention of the Primary Cesarean Delivery published in 2014 suggested doula care as one of many ways to help lower the primary cesarean birth rate.  Citing data from the Cochrane meta-analysis mentioned above they stated, “the presence of continuous one-on-one support during labor and delivery was associated with improved patient satisfaction and a statistically significant reduction in the rate of cesarean delivery. Given that there are no associated measurable harms, this resource is probably underutilized.”

The most recent ACOG support for doula care was published in February 2017. Approaches to Limit Intervention During Labor and Birth stated that “women benefit from continuous emotional support and the use of non-pharmacologic methods to manage pain. Support offered by trained labor coaches such as doulas has been associated with improved birth outcomes, including shortened labor and fewer operative deliveries.”

For decades the benefits of doula care during labor and birth have been researched and documented.  The results have never varied: women and their families benefit in many ways from the emotional and physical support that doulas offer. This is World Doula Week.  Help spread the word! #worlddoulaweek #doulasbenefiteveryone

American College of Obstetricians and Gynecologists. (2017). Approaches to limit intervention during labor and birth. Committee Opinion No. 687. Obstet Gynecol;129:e20–8.
American College of Obstetricians and Gynecologists. (2014). Safe Prevention of the Primary Cesarean Delivery. Obstetric Care Consensus No. 1. American College of Obstetricians and Gynecologists. Obstet Gynecol 2014;123: 693–711.
Kozhimannil KB, Hardeman RR, Attanasio LB, Blauer-Peterson C, O’Brien, M. (2013). Doula care, birth outcomes, and costs among Medicaid beneficiaries. American Journal of Public Health. 103(4), e113-e121.
Hodnett ED, Gates S, Hofmeyr GJ, Sakala C. (2013). Continuous support for women during childbirth. Cochrane Database of Systematic Reviews 2013, Issue 7.
Roberts, Sam. (2016). “Dana Raphael, proponent of breastfeeding and use of doulas, dies at 90”. Retrieved March 15, 2017 from

Infant Nutrition, Best Practice and the Mom/Baby Dyad: Statement on “Fed Is Best”

Recently, the Fed is Best (FIB) Foundation blog blasted social media with a story about an infant named Landon who died at 19 days of age from hypernatremia dehydration. All of us who work in medical and allied medical professions are saddened when such events occur. We question our practice; not wanting it to happen again. The International Childbirth Education Association (ICEA) Board of Directors sends our heartfelt sympathy to Landon’s family.

ICEA stands behind “Freedom to Make Decisions” with all issues and practices encompassing the perinatal period. With that, we need to be diligent in understanding the whole issue. The FIB Foundation is promoting their agenda that exclusive breastfeeding is dangerous. This information is not based on evidence and best practice but rather on rare but scary events.

Exclusive breastfeeding is safe and is the method of infant nutrition endorsed by national authorities including: Centers for Disease Control (CDC), the American Academy of Pediatrics (AAP), the American Academy of Breastfeeding Medicine (ABM), American Academy of Family Physicians (AAFP) and the Association of Women’s Health, Obstetrics and Neonatal Nurses (AWHONN). Additionally, the same practice is endorsed from international authorities such as the World Health Association (WHO), the Canadian Pediatric Society (CPS), and the United Nations International Children’s Fund (UNICEF).

As educators, doulas, lactation professionals, and other allied professionals working with families, we need to remember that there are rare cases that can lead to bad outcomes without further assessment and close follow up care. The Baby Friendly Hospital Initiative (BFHI) is the designating body assisting hospitals with meeting the 10-Steps to Successful Breastfeeding.  Hospitals working under this designation should be using the Guidelines and Evaluation Criteria which state that “additional individualized assistance should be provided to high risk and special needs mothers and infants, and to mothers who have breastfeeding problems”. For many reasons, one being that it was over five years ago, we do not know the specifics behind Landon’s death. Many professionals have questions that cannot be answered. However, it has come to light in news reports that there were possibly some critical factors that put Landon at high risk.

FIB Foundation is promoting that babies should be given formula supplementation as a standard in hospital settings to avoid this type of tragic situation. It is imperative that we remember that rare events should not dictate standard practiceFormula is not risk free and does change the infant’s gut. Changes to the gut can have long term health consequences. Additionally, it can negatively impact the establishment of mother’s milk supply and effect the ability for long term breastfeeding success.

Occasionally, the decision is made to use formula and that falls within the Guidelines and Evaluation Criteria of BFHI. This should be an educated decision between mom and care providers after close assessment, monitoring, and attempts to ensure adequate milk transfer. Hand expression and alternate feeding method are the first choice for supplementation, banked human milk (if available) is the next best alternative. Artificial milk (formula) should be the last choice when supplementation is necessary.

Fed is Best is operating on scare tactics that undermine a woman’s confidence in her body and her baby. Additionally, they are creating a false idea that exclusive breastfeeding practices are rigid and don’t allow for feeding choice or alternate care plans when necessary. Withholding food has never been the agenda of BFHI or other practices that promote exclusivity. Professionals and parents need to have open dialogue about their feeding decisions. Childbirth educators, doulas, and lactation professionals are in the unique role to help guide parents with education and decision making to make the best choice for their baby on an individual basis.

Policy Statements

Supplementation Guidelines

Other Responses to FIB Foundation

The World Breastfeeding Trends Initiative

By Donna Walls, RN, BSN, ICCE, IBCLC, ANLC

The World Breastfeeding Trends Initiative was developed by IBFAN (the International Baby Food Action Network) to provide assessment of policy and programs that impact infant and young child feeding, identify gaps and provide recommendations to countries around the world. In the United States the Initiative was sponsored by The Healthy Children Project.

The Global Strategy for Infant and Young Child Feeding is a guiding document for the initiative. It was adopted by the World Health Assembly  and UNICEF in 2001 and established as a framework with ten action areas to support optimal infant feeding. The specific objectives are to:

  • Raise awareness regarding the main problems affecting infant and young child feeding
  • Identify approaches to solution
  • Provide a framework of essential interventions
  • Increase the commitment of governments, international organizations and other concerned parties for optimal feeding practices for infants and young children
  • Create an environment that will enable mothers, families to make and implement informed choices

Another guiding organization is the Baby-Friendly Hospital Initiative (BFHI) which is an initiative by WHO and UNICEF, providing a program to protect, promote and support breastfeeding in hospital and maternity facilities. The initiative follows the ‘Ten Steps for Successful Breastfeeding’ and ensures adherence to the Code of Marketing of Breast-milk Substitutes.

According to Victora et al (2016) and Rollins et al (2016) breastfeeding could save 820,000 lives annually,  preventing 13% of all deaths of children under five. Breastfeeding could reduce one third of respiratory infections and about half of all diarrhea episodes in low and middle income countries. Breastfeeding has been shown to improve the health and survival of all children.

Globally, optimal infant and young child feeding data shows only 44% of the children born initiate breastfeeding within one hour of birth, only 38% are exclusively breastfed for 6 months, 65% get adequate and appropriate complementary foods at 6-8 months and just 49% continue to breastfeed for at least two years. (WHO, UNICEF)

The assessment was developed to establish a baseline of national policies and programs in place to support optimal infant and child feeding. Scores were provided in a colour- coded rating in Red, Yellow, Blue or Green. In this tool, a score of 90% and above is coded green and considered to be maximum achievement. The other three colours in descending order of performance are Blue, Yellow and Red.

The Assessment Indicators

Part 1 included assessment of policies and programs:

  1. National Policy, Programme and Coordination
  2. Baby Friendly Hospital Initiative
  3. Implementation of the International Code of Marketing of Breastmilk Substitutes
  4. Maternity Protection
  5. Health and Nutrition Care System
  6. Mother Support and Community Outreach
  7. Information Support
  8. Infant Feeding and HIV
  9. Infant Feeding During Emergencies
  10. Mechanism of Monitoring and Evaluation Systems

Part ll assessed practices:

  1. Percentage of babies breastfed within one hour of birth
  2. Percentage of babies 0<6 months of age exclusively breastfed in the last 24 hours
  3. Babies are breastfed for a median duration of how many months
  4. Percentage of breastfed babies less than 6 months old receiving other foods or drinks
  5. Percentage of breastfed babies receiving complementary foods at 6-9 months of age

The United States scored very poorly, with a 37.0 on part 1 and a 31.0 on part 11 for a total of 68.0. The summation of the USA scores can be seen in the report.

Areas for improvement include: increasing mothers initiating breastfeeding within the first hour after birth, improving exclusive breastfeeding rates through the first 6 months of life and increasing the mean duration of breastfeeding. The U.S. scored high on monitoring systems in place but still has work to do on developing national policies supporting breastfeeding (including maternity protection), encouraging hospitals to become designated as Baby Friendly (including evidence-based education to all health care providers working with pregnant and new mothers), implementing the International Code of Marketing of Breastmilk Substitutes, and developing policies for specific conditions such as HIV and breastfeeding in emergencies.

For more information on the WBTI and comparing the US with other countries around the world, go to their website.

UNICEF 2015. State of World Children.
ICN 2 Second International Conference. on Nutrition.
WHO & UNICEF 2016. Baby-friendly hospital initiative congress
Victora CG, Bahl R, Barros AJD, Franca GVA, Horton S, Krasevec J, Murch S, Sankar MJ, Walker N, Rollins NC, for the Lancet Breastfeeding Series Group. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet 2016; 387: 475-90 Rollins NC, Bhandari N, Hajeebhoy N, Horton S, Lutter CK, Martines JC, Piwoz EG, Richter LM, Victora CG, on behalf of the Lancet Breastfeeding Series Group. Why invest, and what it will take to improve breastfeeding practices? Lancet 2016; 387: 491-504. Victora CG, Horta BL, de Mola CL, Quevedo L, Pinheiro RT, Gigante DP, Goncalves H, Barros F. Association between breastfeeding and intelligence, educational attainment, and income at 30 years of age: a prospective birth control study from Brazil. Lancet Glob Health 2015; 3: e199-205.
The Sustainable Development Goals Report 2016. United Nations Children’s Fund, Breastfeeding on the Worldwide Agenda: Findings from a landscape analysis on political commitment for programmes to protect, promote and support breastfeeding, New York, UNICEF, 2013 WHO & UNICEF 2015. Advocacy Strategy Breastfeeding Advocacy Initiative Horton S, Shekar M, McDonald C, Mahal A, Brooks JK. Scaling up Nutrition What will it cost? World Bank 2010. The World Braestfeeding Costing Initiative. The need to invest in babies 2014. The World Braestfeeding Costing Initiative tool 2014. Walters D, Horton S, Siregar AYM, Pitriyan P, Hajeebhoy N, Mathisen R, Phan LTH, Rubert C. The cost of not breastfeeding in Southeast Asia.Health Policy and Planning 2016, 1-10. Shekar M, Kakietek J, Eberwein JD, Walters D. An Investment Framework for Nutrition: Reaching the global targets for stunting, anemia, breastfeeding and wasting. World Bank 2016. Alderman, Behrman and Puett 2016; Copenhagen Consensus Center 2015; Hoddinott et al. 2013). Lutter CK and Morrow AL. Protection, Promotion, and Support and Global Trends in Breastfeeding. AdvNutr 2013; 4: 213219

Remembering Connie Livingston

By Michal Klau-Stevens

I was shocked to learn, on December 29, 2016 when I scrolled through my Facebook feed, that ICEA President Connie Livingston had died suddenly. The post from Barbara Harper caught me off-guard, and left me grappling with the discomfort of processing the loss of a person whom I liked, respected, and felt deep gratitude towards, but had never actually met. Almost all of my interactions with Connie were through social media. I can’t help but think that my life would have been richer if I’d had the opportunity to know her in person too.

Connie was one of the first people to reach out to me through LinkedIn when I started posting my blog posts there. At that time, early in my experience as a blogger, I felt mild panic each time I pushed “publish” on my computer screen, and then it seemed my words went out into the ether and disappeared into nothingness. The kind words in those messages from Connie let me know that my work didn’t disappear – and the fact that the President of ICEA took the time to reach out to connect with me to say that she appreciated my viewpoint meant the world to me. After several months of posting on LinkedIn, Connie asked me, through a private message, if I’d be interested in writing for ICEA. It took a while to make it happen, but her interest inspired me to keep writing and posting on my blog.

Soon we became friends on Facebook, and she regularly commented on my posts, both personal and birth-related. Posts from her frequently showed up on my feed, accompanied by pictures of her smiling face. She was often out with her husband or posting about her children. I remember one tantalizing string of posts she wrote about going out for waffles for breakfast with her daughter, and she and I frequently exchanged posts about guinea pigs. She liked to show off her beloved pet, and I posted her back with the antics of my son’s guinea pig too. Connie posted great birth-related information, and focused on evidence-based care and compassionate treatment for birthing women and their families. I enjoyed reading her blog posts, as I always learned some new and valuable information from her insights.

Earlier in the past year, Connie experimented with another social media platform called Blab, which allowed people to host video chats. Betsy Schwartz, a doula trainer and creator of the board game Down The Canal, was doing chats on Blab and I made of point of joining her in the chat room. Connie came online to watch several chats and interact with us, and before long she was hosting her own Blabs about birth-related topics.  I joined in for a couple of her broadcasts, and it was almost like being in the same room, but not quite. I was impressed with Connie’s bravery to quickly organize her plan and put herself out there to the public on a new, glitchy, visual platform. I was struck by the way she charged forward to seize an opportunity to share her knowledge with others and to interact with people who were interested in talking and learning about birth. That was another valuable life lesson she taught me – seize the day!

It can be hard to get a sense of a person when you only interact through social media, yet there were certain things that came through very clearly. She was a devoted wife and mother, a businesswoman, author, leader, and teacher. Knowing her made me want to work harder and do more so I could achieve like she did, and make a difference by helping others too, as she did. She was a true role model.

Reading the comments and posts after her death made me feel the loss of not knowing her in person even more deeply. So many people wrote about the influence she had in their lives. She touched many birth workers and families in her work over the years, and the posts about her warmth, her sense of humor, her compassion, her wisdom, and her caring were overwhelming.

Thinking about the fact that I won’t be seeing more posts from Connie fills me with sadness. As a former leader of a national birth advocacy organization, I can imagine how her sudden absence will send shock waves through ICEA and the larger birth community as people work to come to terms with this loss of a strong leader who was also a wonderful person. I can only guess, based on what I know from her activity on social media, that she would want her colleagues and students to carry on her work of improving the birth experiences of families through high-quality and compassionate childbirth education, birth support, and advocacy work.

I am so grateful to Connie for giving me the opportunity to contribute to the ICEA community through this blog, and I will do my best to remember the way she had confidence in me and saw value in what I have to share with others. Although much of our relationship was “virtual,” the impact she had on my life was very real. Her death is a great loss to many people and her life was an example of much impact one person can make in the world. She will be missed.

A Tribute to Connie Livingston

By Jamilla R. Walker RN, IBCLC

15826759_10100343898202328_1562172989101568866_nPurely due to the demands of life and the decision to pursue taking on another job outside the home, I’d resigned as the blog manager once 2017 began. While I anticipated writing an end-of-the-year blog for ICEA, I could never in a million years have imagined it would be on this topic.

Social media has been flooded lately with posts about how 2016 needs to end because it keeps “taking” celebrities. Every time I see that, I remember how this happens every year. Every year it’s like there’s some death tax that people can get out of paying if they die before the start of the next year. And every end of December, we strain for the new year to begin so we can be done saying goodbye to greats.

But then I got a message from Barbara Harper last night, telling me how sad she was for Connie. Our dear ICEA President had been given terrible news this past month, with a diagnosis of stage 4 pancreatic cancer for her beloved husband and best friend, Jim. If you’ve had anything to do with Connie Livingston, you know of her complete adoration for Jim. We’ve all been shocked and saddened by his illness, so I assumed that was what she spoke of and agreed that it’s terrible news. My slowness to compute what she was trying to tell me led to me making her spell it out for me. Just like they tell medical providers – it’s not real for family members unless you say the words.

“She coded and DIED?”

“Yes, honey. She died.”

My heart simultaneously lept into my throat and crashed into my stomach, leaving me breathless. I slept fitfully, waiting for the news to break on social media and then torturing myself by reading all the tributes people were posting. We all say the same thing. We’re all reeling from the unexpected devastation.

Connie Livingston was a leader in the birth industry – as a doula, childbirth educator and administrator. Her tenacity and passion for the birth community were second to none, as were her high standards for every organization she laid hands on throughout her career. And while that is impressive, that’s not what has us all walking around in a hazy cloud of grief today. It is how she interacted with all of us that has made us love her, and what is leaving a massive hole in her wake. Connie was the single most encouraging person any of us have ever met. And when I say encouraging, I don’t just mean she was good at making us feel better about life – I mean that she saw our best, our greatest potential and did everything she could to call it out of us. That is essentially what a doula does – a great doula doesn’t just empower. To empower is to give someone power. She gave everything to make each of us see what was always there inside of us. To see what power we held to be game changers, to live our fullest potential as we served the birth community and our families together. She was like this with everyone in her life, to the point that she was typically pretty surprised and disappointed when people turned out not to be what she saw in them. As her friend, I always hated how much it would bother her when someone she’d decided to love turned out to be a jerk. It didn’t happen often, as she was a fantastic judge of character, but when it did – it was hard to watch her work out.

Because when Connie decided to love someone, it was a wholehearted act. You were counted as family and she’d bear hug the breath out of you when she saw you, no matter how much time had passed. The overwhelming consensus from all the social media posts was how many women she mentored over the course of her career. And we didn’t just call her our mentor – she was our mother, our sister, our dearest friend. The other thing about being her friend is how amazing she was at connecting us all. If you talked to her about a problem you were having, she’d know someone with the talent to help you work it out. If you became interested in a certain aspect of the birthing world, she’d send you someone’s phone number having paved the way for you to have a phone chat or Skype – and God forbid you express hesitation (“but Connie, are you SURE it’s ok that I assist Barbara Harper at this conference??”), she’d shoo away your concerns and say, “oh stop, we all put our panties on one foot at a time!”

Friends, what a blessing it was to her to see the outpouring of love for her and her family these last few weeks. She may be gone, but at least she left knowing she was loved. Now it’s time for us to take all the love she gave to each of us, and pour it out on Jim, Heather and Erin and they process this tragic loss. It’s time for us to raise our peppermint mochas in the air and say goodbye to our friend, sister, mentor, mother. We love you so much, Connie. You will be forever missed.

If you took Connie’s doula training, then you’ll remember the candle lighting ceremony at the end. She lit the flames of so many passionate birth workers, and it’s now our turn to carry her light as we continue the work she left for us.